HHRG Worksheet
Inputs For Home Health Services Beginning On Or After January 1,
2020
This appendix describes the components
of the Patient-Driven Groupings Model (PDGM) Grouping worksheet,
which can be found in the most recent PDGM Grouper Tool file found
at https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html.
The following five categories
are required in order to determine the HHRG for each 30-day home
health period under PGDM:
• Timing
• Admission
Source
• Clinical
Grouping
• Functional
Impairment Level
• Comorbidity
Adjustment
Timing: Each
30-day period is identified as either Early or Late.
The first 30-day period is classified as early. All subsequent 30-day
periods in the sequence (second or later) are classified as late.
Admission Source: Each
30-day period is identified by the admission source (institutional
or community) depending on what healthcare setting was utilized
in the 14 days prior to home health admission. Late 30-day periods
are always classified as a community admission unless there was
an acute hospitalization in the 14 days prior to the late home health
30-day period. A post-acute stay in the 14 days prior to a late
home health 30-day period would not be classified as an institutional admission
unless the patient had been discharged from home health prior to
post-acute stay.
Clinical Grouping: Each
30-day period is grouped into one of 12 clinical groups based on
the patient’s principal diagnosis on the claim.
Functional Impairment Level: Each
period is identified as having either low, medium, or high functional
impairment based on the scores for eight OASIS items.
Comorbidity Adjustment: A
low, high, or no comorbidity adjustment may be made based on the presence
of secondary diagnoses on the claim.
Figure 12.B-1 Abbreviated Outcome And Assessment
Information Set (OASIS) Questions
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(To
be used in conjunction with PDGM Grouping Worksheet for payment
of home health periods beginning on or after January 1, 2020 for
children and maternity cases.)
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Figure 12.B-2 HHRG For 60-DAY Episodes Of
Care Beginning On Or After January 1, 2008
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Figure 12.B-3 Abbreviated OASIS Questions
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(To be used in
conjunction with Home Health Resource Group (HHRG) Worksheet for
scoring and payment of home health episodes beginning on or after
January 1, 2008 for children and maternity cases.)
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